Bulge after tummy tuck. Would could this be? (Photo)

In patient like you we perform very agressive liposuction of upper and lower abdomen and lateral portion of flanks as a part of abdominoplasty. Based on thse photos, liposuction of lower and upper abdomen seem to be an option to improve your current result? You should discuss this option with your surgeon or seek in person second opinion consultation. Hope this helps.

Dear laceylynn75,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Your swelling may be internal and not related to your surgery. an examination can tell if it is internal or outside of your muscles. Internal swelling is usually related to food allergies and your diet must be changed to eliminate that swelling.

From your photos there can be a few reasons behind the contour of your abdomen. It could be visceral/internal fat which is the fat behind the muscle wall. This is addressed with weight loss and cannot be corrected with liposuction or a tummy tuck. Next, it could be subcutaneous fat. This is fat that is under the skin, but above the muscle wall. This fat is corrected through liposuction. Yet another potential cause is that the abdominal wall is lax and further tightening of the muscle is needed. This would require a revision to correct.

Nice posted combination photos. I would request an ultrasound of lower abdomen to see if sub dermal fat or failed recti plication. Then either liposuction of lower abdomen or re operation to re plicate recti. Best to virtual consult with....

Thank you for including quality before and after pictures.
There are generally four variables that can change the appearance of the abdomen. Other words if somebody doesn’t like the way, their belly looks it is always because of one or more of these for different tissue variables. The four variables are abdominal skin laxity, excess subcutaneous fat, muscle separation from previous pregnancy and excess visceral or intra-abdominal fat.
We can rule out skin redundancy because of the surgery. Based on your overall appearance, I don’t think subcutaneous fat is contributing all that much. This means that the bulging see the related insufficient muscle tightening or access visceral fat.
Differentiating between the two accurately requires an examination. There are a few things you can do it yourself to help differentiates.
One way is to determine what your abdominal wall looks like when you lay on your back.
If it’s still bulges while laying on your back, then visceral fat is most likely contributing significantly.
The other way to help determine if visceral fat is contributing, or if this is insufficiently corrected, muscle separation is depress your abdomen a flat with your non-dominant hand. If this takes a significant amount of pressure, then again, the visceral fat may be the underlying problem.
If it’s fairly easy to press, your abdomen until it’s flat, then your surgeon may have not been aggressive enough with muscle tightening. Subcutaneous fat can also be contributing to some degree and Liposuction may be warranted if the fat layer is thick enough to have a substantial impact, if reduced.
To determine the thickness of your subcutaneous, fat layer, take the tip of your finger and gently pressed against the skin until you feel the muscle wall. This requires very little pressure. You can practice doing it over your ribs or other areas to get a sense of how thick your subcutaneous fat layer is. My best guess is that your fat layer on your mad at them and it’s probably 1 inch.
Well done Liposuction could bring in your abdomen by about 3/4 of an inch. If you’re fat layer is 1 inch thick.
To get a more accurate assessment, I suggest having a few in person consultations with other plastic surgeons in your community. To have a proper second opinion consultation patients should come prepared. Bring with them all before and after pictures and preferably a copy of your operative report which you can get from your surgeons office by requesting it.
Make sure your surgeon included the muscle tightening in your discussion. If muscle tightening was not part of the conversation or was not done, and that would be a simple explanation for why your abdomen still bulges.
Good luck,
Mats Hagstrom MD